| National Provider Identifier [NPI]: | 1760631592 |
| Last Name Of The Provider | WILSON |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 638 CAMINO DE LOS MARES STE D |
| Street Address 2 Of The Provider | MINUTE CLINIC 8882 |
| City Of The Provider | SAN CLEMENTE |
| Zip Code Of The Provider | 92673 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 640 |
| Number Of Medicare Beneficiaries | 321 |
| Total Submitted Charge Amount | 21581.35 |
| Total Medicare Allowed Amount | 20998.69 |
| Total Medicare Payment Amount | 18030.99 |
| Total Medicare Standardized Payment Amount | 19803.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 268 |
| Number Of Medicare Beneficiaries With Drug Services | 257 |
| Total Drug Submitted ChargeAmount | 7426.35 |
| Total Drug Medicare AllowedAmount | 7367.07 |
| Total Drug Medicare PaymentAmount | 7219.08 |
| Total Drug Medicare Standardized Payment Amount | 7219.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 372 |
| Number Of Medicare Beneficiaries With Medical Services | 321 |
| Total Medical Submitted Charge Amount | 14155 |
| Total Medical Medicare Allowed Amount | 13631.62 |
| Total Medical Medicare Payment Amount | 10811.91 |
| Total Medical Medicare Standardized Payment Amount | 12584.05 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 196 |
| Number Of Male Beneficiaries | 125 |
| Number Of Non Hispanic White Beneficiaries | 302 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 8 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8241 |